Lead Author, The HCAHPS Imperative for Patient-Centered Excellence

Tag: Compassion

This week I had two humbling opportunities to contribute to the national patient experience dialogue and share deep convictions for compassion in health care. Gregg Loughman, General Manager & Vice President of PX Solutions at HealthStream, and I presented a webinar series, hosted by The Beryl Institute, on the CAHPS Imperative for Patient-Centered Care. I also had the honor to travel to New York City for an interview with CBS News to discuss the impact of surveys in improving the patient experience.

By Establishing the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, Centers for Medicare and Medicaid Services (CMS) took bold and progressive steps to spark a conversation about the importance of every patient having a voice in the quality of care received. Until that point, the patient experience was considered a “nice to do” and now the patient experience is among the top priorities for healthcare executives, staff and providers.

Whether you love or hate any patient experience survey, they have been designed by patients and their loved ones to convey the behaviors that reflect quality care. There is no doubt that working to achieve the level that “Always” or “Best Possible Hospital” requires; however most times we would want those same criteria for our loved ones. We cannot have two separate standards for what we would want and what we provide.

The CAHPS Surveys were never designed for organizations and caregivers to chase scores or penalize. They were created to capture feedback on the total health care experience and give data to help develop competencies that lead to safer, higher quality care. The feedback creates opportunities to celebrate the best in our organizations and improve reliability at the bedside.

Recent research that I have had the opportunity to conduct has demonstrated that high performing cultures lead to a more engaged workforce, better patient experience performance, lower turnover rates and more favorable performance with value-based care measures. I encourage everyone to take the CAHPS Survey that most applies to their work area. Take the survey from the shoes, slippers and gowns of your patients. Use this as an opportunity to talk about why the patient experience matters in your organization. To me, the government never needed to mandate compassion but their progressive steps created recognition that compassion is a human imperative- every person, every time.

It’s hard to believe that 2016 is almost over. With the holiday season upon us and the hustle and bustle of getting it “all done,” it’s easy to focus on the areas that aren’t working and the times we feel we are less than perfect. In our busyness, we can soon forget the moments that bring us joy. We should all be still for a moment and be reminded of why our professions in healthcare are so profound. Two influences impacted my focus for this November blog: a lunch outing with my family and a recent interview I had with Win Howard, CEO Asante Three Rivers Medical Center.

My family recently visited one of our favorite waterfront restaurants on Fort Walton Beach, The Gulf. While trying to enjoy my lunch I was also entertaining my rambunctious four-year-old son when suddenly I was captivated by a sign that steered my attention.

So many times, I hear leaders, staff, and providers experiencing burnout…overwhelmed with the “to do”s, frustrated by the growing documentation and protocols, the heightened emotions faced with the rising expectations of patient care. Yet, in my experience, the best days we have are when we can look back on any given day and see the good that happened and that we were able to share with those we touched. What I love about this message is we get to choose… We get to decide each day how we want to spend 1440 minutes in 24 hours. Do we want to spend it doing good for others or live in frustration and anguish? I bet for all of us who have been patients or loved ones of patients, we want every single person to be engaged and focused on making our experience one filled with compassion and high-quality care.

We found in our HealthStream Benchmarking Study on healthcare workforce engagement, that leaders are three times more engaged than their direct reports. We have to find ways to create daily inspiration and reconnect our teams to purpose. Here are a few ideas to create engagement despite our distractions.

Put excellence on a pedestal

Seek out what is working well. Begin each staff meeting with thanksgiving, reward, and recognition. Ask team members about moments made them proud. Ask patients what has made their visit or stay excellent. Get specific details so you can share with your team. There are plenty of times to address areas of improvement for quality, patient experience, and financial performance. Try your best to create environments where you build on your bright spots while you close gaps in other areas.

Obtain and share stories

In my interview with Win Howard, Win talks about the profound experiences that have impacted his leadership in creating a more patient-centered culture at Asante. Win is an accomplished CEO with high levels of employee engagement and patient experience outcomes, designations for patient quality, yet when he speaks about the moments that have created the most memorable experiences, they are ones of care and compassion- especially at the most difficult times.

Create visual cues and contagious experiences

Keeping focused amidst distraction requires attention, yet when you enlist others you get a contagious movement. Enlist your teams to have compassionate scavenger hunts. Take pictures using your mobile device to bring back examples from your daily activities or life outside of work (of course in compliance with your digital and social technology policies).

As we move into the last month of the year, let’s make demonstrable gains to restore engagement and put the culture we want at the forefront. There is no time to wait until this becomes a New Year’s resolution.

Taking on the role of a patient is one commonality we all share. Whether we have been one at an urgent care, to have a child, to fix a broken bone, seek treatment for a chronic condition we are all a part of the healthcare ecosystem. I have the privilege to work with thousands of healthcare leaders, staff, and providers each year – it is one that I do not take lightly. I work hard to stay on top of industry trends and remain connected to the daily demands of patient care across the continuum. It is fair to say that Healthcare takes up the majority of my daylight hours (sound familiar?). And I feel compelled to play a positive role in making healthcare better because every patient is a person who wants the very best care possible. The human experience matters. Compassion matters.

The reality is that we spend more time at work and with our co-workers, patients, and visitors than our own families and loved ones. We are people taking care of other people – in their greatest time of need, where uncertainty and the need for reassurance peaks.

So many times, leaders ask me, “What matters most to drive outcomes; focusing on engaging your employees or patients?” I have given this question tremendous reflection over many site visits with hospitals and health systems, as well as my families own personal healthcare journeys over the years. I have come to the conclusion that as healthcare leaders, employees, and providers, we need to unapologetically establish and promote cultures of person-centered excellence. Cultures where each person is treated with respect, dignity, and accountability. At the heart of person-centered excellence is actively displaying compassion and empathy for each individual.

In thinking about times when I have personally been a patient (and researched my own symptoms online – to which I am not alone. It is estimated that over two-thirds percent of patients Google their symptoms prior to an office visit), every team member has made me feel that I am in good hands by demonstrating compassion (or made me feel uneasy by failing to demonstrate compassion).

Every interaction that you have is an opportunity to demonstrate person-centered excellence in action by displaying empathy and compassion or denigrate it. Your presence with your employees, providers, patients, visitors and community matters.

Honestly, nearly all of us strive to be empathetic and compassionate (granted there are some CAVE People – Citizens Against Virtually Everything), yet too often I see a disconnect between an individual’s intent and the perceptions of the recipient. There are three likely scenarios where we can close gaps (and the good news is that none of these require additional budgetary dollars).

Among leaders and employees

As a leader, do not assume your team knows all of the tremendous work you do behind the scenes. Communicate often and genuinely. Be visible, always make eye contact and engage your employees. If your team members do not feel and experience compassion from you, how can you expect them to give it to your patients?

With patients and their loved ones

As caregivers, we must recognize that every patient and loved one that comes through our doors (regardless of where – the Lab, Emergency Department, Imaging, Inpatient, Medical Office) sees themselves as the most important person. Healthcare is unfamiliar to them, they likely have fears/anxieties and want to be reassured they are going to receive quality, compassionate care. We need to set expectations early and often, display empathetic and compassionate behaviors and never assume patients understand what we are doing and why.

Among peers

Since we spend more time with our peers than our loved ones, we need to explore ways to empathize with one another. Sometimes this takes a degree of courage to confront matters of safety, avoid errors or hold people accountable. I was recently shadowing bedside shift reporting with an organization and noticed a pair of nurses doing their end of shift report outside of the room. The retiring nurse later shared with me that she “knows” they are supposed to do their shift report in the room with the patient but does not feel confident in speaking up with those who are not onboard with the initiative. Everyone loses when we miss opportunities to cultivate peer-to-peer empathy and compassion.

Let’s get excited to seek out opportunities to Cultivate Person-Centered Excellence by establishing essential appreciation of the human experience in key roles to walk in patient’s crutches or slippers, wear the employee badge or the leadership hat. I can promise you, it will be a more rewarding voyage than focusing on what is not working in healthcare today.

The success of our healthcare organization
DEPENDS UPON THE WAYS WE INTERACT AND ENGAGE WITH PATIENTS AND EACH OTHER. WE KNOW PATIENTS ARE
IMPACTED BY EVERY PERSON WHO COMES IN CONTACT WITH THEM OR THEIR FAMILIES. AS INTEGRAL PARTICIPANTS IN
HEALTHCARE, WE HAVE A VITAL ROLE TO PLAY IN OUR PATIENTS’ PERCEPTIONS OF THEIR EXPERIENCES. IT IS THE MOMENTS THAT MATTER.

Patients begin to evaluate a healthcare experience long before they enter a facility. Whether the first encounter is by telephone or with a valet service in the parking lot, patients and family members begin to judge the quality,
safety, and service of the organization before they reach the front door. It is not only what we say but how we sound and the way we look that impact what a patient and family take away from a healthcare experience. We
are each ambassadors for the mission and vision of our organization, and we have the opportunity to represent our hospitals, emergency departments, ambulatory settings, and post-acute facilities positively or negatively.
It is up to us to let patients know we care, through every action, every word, every interaction.

WHAT ARE THE MOMENTS THAT MATTER?

Moments that Matter encompasses the idea that all healthcare personnel have an impact on patients’ healthcare experiences. By understanding, empathizing, and developing ways to deliver an excellent experience, healthcare workers are in a unique position to impact lives. Whether we provide clinical care or not, each of us is integral, not only to the outcome of a single event, but to the way in which people approach healthcare moving forward.
There are eight primary principles for creating Moments That Matter; they include purpose, empathy, trust, communication, teamwork, accountability, appearance, and attitude. While these principles are easy to identify, they require mindful practice to live every day. A connection with purpose requires asking and answering the fundamental question, “Why did I choose healthcare?” Drawing on purpose means the person washing sheets understands he or she contributes to the health and well being of every patient. It means the parking lot attendant knows he or she makes the journey to the front door easier for many people. Empathy is a quality many of us embody; it draws us to healthcare. And, it requires we put ourselves in the other’s place and that we attempt to understand another human being at a very deep level. Likewise, trust is crucial; trust in ourselves, in our areas, and in our organizations. Underpinning many of these principles is effective communication, the ability not only to speak clearly and transparently but also to listen well to what is said and what is left unsaid. Being part of a high performing team means that we share a collective vision, know where the team is headed, carry our weight, and reward each other regularly. Associated with effective teamwork is accountability. Accountability ensures we follow through on our commitments and do what we say we will do. Professional appearance is an important principle in that it engenders confidence in our skills and in our organization. Finally, attitude provides the capstone; attitude is a choice that helps our patients know they matter to us.

MARY’S JOURNEY THROUGH THE CONTINUUM OF CARE AND THE MOMENTS THAT MATTER

Let’s examine Moments That Matter by walking through a healthcare experience with Mary. Mary’s journey begins at home. She contacts her primary care provider’s office after hours when she experiences unexplained stomach
pain for several days. She speaks with the office nurse who consults her physician and recommends Mary go to the local emergency department. A Moment That Matters occurs as the nurse reassures and listens to Mary, acts
with confidence, and empathizes by reflecting Mary’s concerns to make sure she understands.

On arrival at the emergency department, Mary notices she must park far from the door. On her way in, she sees trash in the parking lot and worries about the cleanliness of the facility. An early, critical Moment That Matters has been missed. Now, in addition to her pain, Mary experiences anxiety about the treatment she will receive, worrying that if the parking lot is dirty, the hospital may be also.

Entering the ED, Mary is greeted by a Plexiglas window bearing many notices; there are almost too many read. Through a small opening, Mary sees a person looking at a computer screen. Although Mary approaches the opening, the person does not look up. Another crucial Moment That Matters has been wasted. From the uninviting window to the lack of human connection, Mary now feels uneasy about what lies ahead.

Fortunately, the remainder of her ED visit goes very well, with clinicians keeping her informed of the time test results will require and helping to manage her pain. Using excellent communication skills and following through on commitments has helped Mary regain confidence in the hospital and in the ED team and has contributed successful Moments That Matter to Mary’s perception.

Mary learns she is to be admitted for observation. Her hospitalist and the nursing team on the floor exhibit excellent patient experience skills, updating Mary’s white board, narrating their care when explaining tests and time-frames, and being genuinely interested in Mary and her son, who is now with her. She notices that the housekeeper asks whether he can close the door for her privacy when leaving and the person delivering her tray calls her by name, smiling and looking her in the eye when entering the room. Each of these experiences demonstrates a Moment That Matters, and Mary feels relieved.

When Mary’s illness has been diagnosed and she is ready to leave, she is met by a member of the transport team. This transporter has the choice to impact Mary positively or negatively. He will be the final person Mary encounters while in the hospital, and his words and actions are another opportunity for a Moment That Matters. He looks Mary in the eye, smiles, and helps her into a wheelchair, saying, “We want to make sure you are safe, even when you’re going home. We’re so glad you chose our hospital for your care.”

As Mary travels home, she reflects on her experience. For her, it began, not with the emergency department or her stay on a hospital floor, but with a call to her doctor. She sees the entire experience as one event. And, while we like to think Mary will hold a positive overall opinion of her experience, not all aspects have been positive, and Mary may view the totality of the visit either positively or negatively.

The challenge for each of us in healthcare is to show up fully and to enter into our work wholeheartedly, knowing that we each have opportunities for providing Moments That Matter every day. Regardless of our role or title, it is only when we offer an excellent experience to every patient, every time that we have succeeded in living the principles embodied in Moments That Matter.

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Thinking of all the strong, powerful women on the CPQCC staff and at our member hospitals who work tirelessly to ensure that every pregnant woman and infant in California is given an equal chance to thrive. Today and every day we #Pressforprogress #IWD2018